PATIENTS COVERED BY MEDICARE DESERVE ACCESS TO CGM: By Francine Ratner Kaufman, MD

LETTER FROM THE MEDTRONIC DIABETES CHIEF MEDICAL OFFICER

PATIENTS COVERED BY MEDICARE DESERVE ACCESS TO CGM:

WHAT WE’RE DOING... AND WHAT YOU CAN DO, TOO

BY FRANCINE RATNER KAUFMAN, MD

Want even more In the Know? Check out our Diabetes Educator Page for easy access to current and past articles, organized by date and topic.
Over the last few years, there has been mounting evidence that continuous glucose monitoring (CGM) used in conjunction with insulin pump therapy (CSII) improves glucose outcomes1,2 and that CGM is a valuable diabetes management tool. As a result, CGM technology is recommended by national diabetes clinical guidelines.3

At the present time, an estimated 99.5% of private insurers cover CGM for qualified patients. For example, United Healthcare recently announced it would cover sensor-augmented pump (SAP) therapy for patients with type 1 or type 2 diabetes who meet specific clinical criteria that they feel can be benefited by SAP.

LACK OF ACCESS VIA MEDICARE

However, Medicare does not yet cover CGM. This means those aged 65 years and greater on Medicare do not have access to this important technology. The lack of CGM access could leave these patients more vulnerable to dangerous glucose excursions, particularly hypoglycemia, potentially increasing hospitalization rates and emergency department visits.

Medicare beneficiaries are being denied coverage for CGM because the Centers for Medicare and Medicaid Services (CMS) has stated that CGM technology does not meet the Medicare definition of durable medical equipment—and it currently does not fall under any other Medicare category.

This has to change.

WORKING TOGETHER—FOR CHANGE

Medtronic Diabetes strongly believes that CSII with CGM should be available to all eligible patients, including those covered by Medicare. In addition, coverage of this important technology by Medicare should help advance artificial pancreas systems, of which CGM is an important component.

For nearly 2 years, Medtronic Diabetes has been collaborating with a coalition of patient advocate groups—including the Juvenile Diabetes Research Foundation (JDRF), clinical societies, and industry partners—who are focused on the mutual goal of obtaining CGM access for Medicare patients.

One of our biggest victories to date was the re-introduction this past March of the “Medicare CGM Access Act of 2015” bill (S. 804) in the Senate, along with the re-introduction of the bipartisan companion bill (H.R. 1427) by the same name in the House of Representatives4 (the bills were originally introduced in 2014, but needed to be reintroduced due to the start of the new Congress). If passed, these legislative initiatives would provide Medicare coverage of CGM for “CGM-qualified individuals.” At the present time, the H.R. bill had been referred to the House Energy and Commerce and Ways and Means Committees.

HOW YOU CAN HELP

HOW YOU CAN HELP If you have seen how CGM can benefit people on CSII and would like to see coverage extended to your Medicare-insured patients, here are some steps you can take to help:

  • You can contact your Congresspersons to urge them to co-sponsor the Medicare CGM Access Act of 2015. Click here5 and here6 to access forms set up by JDRF that you can personalize—perhaps with some CGM success stories that you have seen in your patients and why you feel the technology is clinically necessary. JDRF makes it easy to find your Congresspersons, and you can personalize and send your letters directly from the website.
  • You can also sign JDRF’s petition7 urging CMS to ensure that those with Medicare have access to life-saving CGM technologies.

After you take these actions, please share this message, asking your friends and family to do the same. You can also spread the word on social media channels using hashtag #MedicareCoverCGM.

Stay tuned: We hope that more good news will follow—for you, and your patients.

SOURCES
1Bergenstal RM, Tamborlane WV, Ahmann A, et al; for the STAR 3 Study Group. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med. 2010;363(4):311-320.

2Battelino T, Conget I, Olsen B, et al. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomized controlled trial. Diabetologia. 2012;55:3155-3162.

3Grunberger G, Abelseth JM, Bailey TS, et al. Consensus Statement by the American Association of Clinical Endocrinologists/American College of Endocrinology Insulin Pump Management Task Force. Endocr Pract. 2014;20(5):463─489. Available at: https://www.aace.com/files/insulin-pump-management-cs.pdf. Accessed May 29, 2015.

4JDRF Advocacy Facebook Page. Juvenile Diabetes Research Foundation. https://www.facebook.com/JDRFAdvocacy/posts/10152819652403877?comment_id=10152836148413877&offset=0&total_comments=7&comment_tracking={%22tn%22%3A%22R%22}. Posted March 19, 2015. Accessed May 29, 2015.

5Urge your representative to co-sponsor H.R. 1427 to ensure seniors with diabetes have access to continuous glucose monitors. Juvenile Diabetes Research Foundation. https://www2.jdrf.org/site/Advocacy?cmd=display&page=UserAction&id=418. Accessed May 29, 2015.

6Urge your senators to co-sponsor S. 804 to ensure seniors with diabetes have access to continuous glucose monitors. Juvenile Diabetes Research Foundation. https://www2.jdrf.org/site/Advocacy?cmd=display&page=UserAction&id=412. Accessed May 29, 2015.

7JDRF [author]. Tell Medicare to cover continuous glucose monitors for people with diabetes. Care2 Petitions. http://www.thepetitionsite.com/takeaction/776/978/446/. Accessed May 29, 2015.

Francine Ratner Kaufman, MD, is Chief Medical Officer and VP of Global Clinical, Medical and Health Affairs at Medtronic Diabetes in Northridge, Calif.; a Distinguished Professor Emerita of Pediatrics and Communications at the Keck School of Medicine and the Annenberg School of Communications of the University of Southern California; and an attending physician at Children’s Hospital Los Angeles. Dr. Kaufman has published more than 220 peer-reviewed and invited publications and is the author of more than 40 books or book chapters. In 2012, she authored the Insulin Pump and Glucose Sensor Book for the American Diabetes Association (ADA) and edited the 6th edition of the ADA’s Medical Management of Type 1 Diabetes. In 2005, her book Diabesity was published by Bantam. Dr. Kaufman was chair of the National Institutes of Health-funded Studies to Treat (the TODAY Trial) or Prevent (the HEALTHY Trial) Type 2 Diabetes in Youth (STOPP-T2). Dr. Kaufman has served as president of the American Diabetes Association (2002-03), chair of the National Diabetes Education Program, and chair of the Youth Consultative Section of the International Diabetes Federation. She is a member of the Institute of Medicine and served on the Advisory Council of the NIDDK branch of the NIH. Dr. Kaufman received her Doctorate of Medicine from Chicago Medical School, Chicago, Ill., where she was valedictorian. She completed her internship (Pediatrics), residency (Pediatrics), and fellowship (Pediatric Endocrinology) at Children’s Hospital of Los Angeles, Los Angeles, Calif.